老年病人非心脏手术术后呼吸衰竭的危险因素分析  

Risk factors contributing to postoperative respiratory failure in elderly patients after noncardiac surgery

作　　者：张鸿[1] 薛张纲[1] 蒋豪[1] 孙大金[2] 杭燕南[2] 王祥瑞[2] 庄心良[3] 李士通[3] 徐惠芳[4] 江伟[4] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海市200032 [2]上海第二医科大学附属仁济医院 [3]上海市第一人民医院 [4]上海市第六人民医院

出　　处：《中华麻醉学杂志》2004年第2期94-97,共4页Chinese Journal of Anesthesiology

摘　　要：目的 分析老年病人行非心脏手术术后发生呼吸衰竭的危险因素。方法按前瞻性随机临床队列研究设计,收集四个中心的582份合格病例进行分析。应用单因素比较和多因素Logistic回归方法,分析围术期危险因素和老年病人术后呼吸衰竭发生的关系。呼吸衰竭定义为术后机械通气48 h以上或全麻拔管6 h后再插管行机械通气。结果 共有51例患者发生术后呼吸衰竭(8.8％),多因素logistic回归分析显示手术种类、ASA分级、慢性阻塞性肺病(COPD)病史和低白蛋白水平与老年病人术后呼吸衰竭的发生有关。结论 临床上可根据手术种类、ASA分级、COPD病史和低白蛋白水平预测并采取相应措施,以减少术后呼吸衰竭的发生。Objective To analyze the risk factors associated with postoperative respiratory failure (PRF) in elderly patients undergoing noncardiac surgery. Methods In a prospective randomized joint study, 582 patients conforming to the criteria established by the four medical centers were enrolled for analysis. Univariate analysis and multivariate logistic regression analysis were used to examine the relations between perioperative risk factors and PRF. PRF was defined as mechanical ventilation after operation lasting for more than 48h or reintubation and mechanical ventilation within 6h after extubation.Results Fifty-one patients developed PRF (8.8%) . Multivariate logistic regression analysis identified that the type of surgery, ASA physical status classification, history of COPD and plasma albumin < 35 g· L-1 were the significant predictors of PRF. The types of surgery in the order of risk were neurosurgery, abdominal aneurysm surgery, thoracic surgery > upper abdominal surgery and peripheral vascular surgery. The reason that neurosurgery topped the list was that most neurosurgical patients suffered from severe head injury and postoperative mechanical ventilation was prolonged because of coma. Our study showed that physical status was also a significant predictor of PRF. According to ASA classification, one class higher increased the risk by 6.325 time s. Conclusion Based on these predictors of PRF, in high risk elderly patients necessary measures can be taken to decrease the development of PRF.

关 键 词：老年病人 非心脏手术 术后并发症 呼吸衰竭 危险因素 围手术期 

分 类 号：R619[医药卫生—外科学] R563.8[医药卫生—临床医学]